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e multibacilar &#40;MB&#41;&#44; mais de cinco les&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O tratamento poliquimioter&#225;pico &#40;PQT&#41; recomendado pela OMS em&#160;1982 foi decisivo para a redu&#231;&#227;o global da preval&#234;ncia da hansen&#237;ase&#46; Casos PB s&#227;o tratados durante seis meses com rifampicina e dapsona&#59; casos MB recebem&#160;12&#160;meses de tratamento com os mesmos f&#225;rmacos&#44; associados a clofazimina&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Face ao conhecimento da possibilidade de cura espont&#226;nea de casos PB com les&#227;o cut&#226;nea &#250;nica &#40;PB&#8208;LU&#41;&#44; em 1998 a OMS recomendou estudos com dose &#250;nica de rifampicina 600&#160;mg&#44; ofloxacina 400&#160;mg e minociclina 100&#160;mg&#44; associa&#231;&#227;o medicamentosa denominada esquema ROM&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Um dos primeiros estudos com o esquema ROM foi realizado na &#205;ndia&#44; com&#160;1&#46;483 pacientes&#46; Comparou&#8208;se o esquema ROM com o tratamento PQT para casos PB&#46; Nesse ensaio cl&#237;nico randomizado&#44; 1&#46;381&#160;doentes completaram o estudo e&#44; ao final de&#160;18&#160;meses&#44; verificou&#8208;se a cura cl&#237;nica de 99&#44;2&#37; dos casos&#46; N&#227;o houve diferen&#231;a entre os &#237;ndices de cura dos enfermos alocados nos dois esquemas&#44; PQT e ROM&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">No Brasil&#44; no per&#237;odo de outubro de&#160;1997 a novembro de&#160;1998&#44; foi realizado estudo multic&#234;ntrico delineado como coorte prospectiva&#44; constitu&#237;da por&#160;259&#160;pacientes portadores de hansen&#237;ase PB&#8208;LU&#58; 75&#160;no estado do Amazonas&#44; 59&#160;em Goi&#225;s&#44; 80&#160;no Rio de Janeiro e 45&#160;em Rond&#244;nia&#46; Todos foram tratados com o esquema ROM e tiveram mediana de tempo de seguimento de&#160;31&#160;meses&#46; No seguimento&#44; 216&#160;&#40;83&#44;4&#37;&#41; casos foram avaliados como curados&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">De acordo com os dados da literatura mundial e os resultados do estudo brasileiro&#44; o Minist&#233;rio da Sa&#250;de do Brasil &#40;MS&#41;&#44; em&#160;2002&#44; recomendou o esquema ROM como tratamento alternativo em centros de refer&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">No &#250;ltimo guia de controle da hansen&#237;ase &#40;MS&#44; 2017&#41; n&#227;o h&#225; refer&#234;ncia sobre o tratamento ROM e inexistem explica&#231;&#245;es sobre sua exclus&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Por outro lado&#44; nas recomenda&#231;&#245;es para o tratamento da hansen&#237;ase&#44; em&#160;2020&#44; a OMS continua recomendando o esquema ROM&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Procuramos avaliar a evolu&#231;&#227;o cl&#237;nica dos&#160;75&#160;pacientes do estado do Amazonas alocados no estudo brasileiro&#44; principalmente com rela&#231;&#227;o &#224; ocorr&#234;ncia de eventos como rea&#231;&#245;es&#44; neurites e retratamento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para essa an&#225;lise&#44; foram realizadas buscas no banco de dados do Sistema de Informa&#231;&#227;o de Agravos de Notifica&#231;&#227;o &#40;SINAN&#41; e seus prontu&#225;rios&#46; Apenas um prontu&#225;rio n&#227;o foi localizado&#46; Procuramos tamb&#233;m resgatar pacientes para exame dermatol&#243;gico&#44; por meio de contato telef&#244;nico&#46; Nenhum paciente foi localizado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Na investiga&#231;&#227;o do banco de dados do SINAM n&#227;o foi encontrada informa&#231;&#227;o sobre reingresso de pacientes por falha terap&#234;utica&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Por meio da an&#225;lise dos prontu&#225;rios&#44; verificou&#8208;se que&#160;33&#160;pacientes retornaram ao servi&#231;o&#58; 19&#160;com queixas n&#227;o relacionadas &#224; hansen&#237;ase e 14&#160;para reavaliar a enfermidade&#46; De acordo com as informa&#231;&#245;es coletadas&#44; quatro pacientes apresentaram sinais de prov&#225;vel reativa&#231;&#227;o da doen&#231;a&#44; cinco a seis anos ap&#243;s o tratamento &#8211; tr&#234;s casos informavam reativa&#231;&#227;o ou aumento do tamanho da les&#227;o&#44; e um&#44; classificado como indeterminado&#44; desenvolveu neurite &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Nos prontu&#225;rios n&#227;o havia informa&#231;&#245;es sobre resultados de bi&#243;psias ou baciloscopias positivas&#46; Os exames dermatol&#243;gicos n&#227;o foram realizados pelos dermatologistas envolvidos na pesquisa&#46; Os crit&#233;rios de falha terap&#234;utica&#44; ap&#243;s 20 anos&#44; foram exclusivamente cl&#237;nicos e n&#227;o tiveram comprova&#231;&#227;o definitiva da inefic&#225;cia do tratamento&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Ressaltamos que o esquema ROM &#233; recomendado pela OMS e deve ser considerado como esquema alternativo para tratamento dos casos PB com les&#227;o &#250;nica&#44; principalmente nos centros de refer&#234;ncia&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0070" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado do Amazonas &#40;FAPEAM&#41; &#8211; bolsa inicia&#231;&#227;o cient&#237;fica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0075" class="elsevierStylePara elsevierViewall">Silmara Navarro Pennini&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o&#44; revis&#227;o e aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Josineide de Oliveira Novo Fran&#231;a&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e revis&#227;o do manuscrito&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Paula Frassinetti Bessa Rebello&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Sin&#233;sio Talhari&#58; Revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o&#44; revis&#227;o cr&#237;tica do manuscrito e aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Como citar este artigo&#58; Pennini SN&#44; Fran&#231;a JO&#44; Rebello PF&#44; Talhari S&#46; Single&#8208;lesion paucibacillary leprosy&#58; a retrospective study of 75 cases treated with the ROM scheme&#46; An Bras Dermatol&#46; 2022&#59;97&#58;258&#8211;9&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seguimento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Classifica&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Manifesta&#231;&#227;o cl&#237;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">M&#234;s de ocorr&#234;ncia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conduta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="9" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tr&#234;s anos<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&#47;histologia MB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;MB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neurite &#40;dois nervos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;MB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento do n&#250;mero de les&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falha terap&#234;utica&#47;aumento da les&#227;o inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vinte anos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falha terap&#234;utica&#47;aumento da les&#227;o inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Carta ‐ Investigação
Hanseníase paucibacilar com lesão única: estudo retrospectivo de 75 casos tratados com o esquema ROM
Silmara Navarro Penninia,b,c,
Corresponding author
snp.ddt18@uea.edu.br

Autor para correspondência.
, Josineide de Oliveira Novo Françad,e, Paula Frassinetti Bessa Rebelloc, Sinésio Talharia,b,c
a Programa de Medicina Tropical da Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, AM, Brasil
b Universidade do Estado do Amazonas, Manaus, AM, Brasil
c Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brasil
d Universidade Federal do Amazonas, Manaus, AM, Brasil
e Programa de Iniciação Científica da Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta em Colaboração com a Fundação de Amparo à Pesquisa do Estado do Amazonas, Manaus, AM, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A hansen&#237;ase&#44; doen&#231;a infectocontagiosa ocasionada pelo <span class="elsevierStyleItalic">Mycobacterium leprae</span>&#44; ainda constitui problema de sa&#250;de p&#250;blica no Brasil&#46; Em&#160;2018 foram registrados&#160;28&#46;660&#160;casos novos&#44; o que corresponde a&#160;93&#37;&#160;dos pacientes diagnosticados no continente americano&#46; Nesse mesmo ano&#44; Brasil&#44; &#205;ndia e Indon&#233;sia contribu&#237;ram com&#160;80&#37; dos&#160;208&#46;619&#160;casos novos registrados em todo o mundo&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Para fins operacionais&#44; em&#160;2009 a OMS recomendou classificar a hansen&#237;ase segundo o n&#250;mero de les&#245;es cut&#226;neas&#58; paucibacilar &#40;PB&#41;&#44; uma a cinco les&#245;es&#59; e multibacilar &#40;MB&#41;&#44; mais de cinco les&#245;es&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O tratamento poliquimioter&#225;pico &#40;PQT&#41; recomendado pela OMS em&#160;1982 foi decisivo para a redu&#231;&#227;o global da preval&#234;ncia da hansen&#237;ase&#46; Casos PB s&#227;o tratados durante seis meses com rifampicina e dapsona&#59; casos MB recebem&#160;12&#160;meses de tratamento com os mesmos f&#225;rmacos&#44; associados a clofazimina&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Face ao conhecimento da possibilidade de cura espont&#226;nea de casos PB com les&#227;o cut&#226;nea &#250;nica &#40;PB&#8208;LU&#41;&#44; em 1998 a OMS recomendou estudos com dose &#250;nica de rifampicina 600&#160;mg&#44; ofloxacina 400&#160;mg e minociclina 100&#160;mg&#44; associa&#231;&#227;o medicamentosa denominada esquema ROM&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Um dos primeiros estudos com o esquema ROM foi realizado na &#205;ndia&#44; com&#160;1&#46;483 pacientes&#46; Comparou&#8208;se o esquema ROM com o tratamento PQT para casos PB&#46; Nesse ensaio cl&#237;nico randomizado&#44; 1&#46;381&#160;doentes completaram o estudo e&#44; ao final de&#160;18&#160;meses&#44; verificou&#8208;se a cura cl&#237;nica de 99&#44;2&#37; dos casos&#46; N&#227;o houve diferen&#231;a entre os &#237;ndices de cura dos enfermos alocados nos dois esquemas&#44; PQT e ROM&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">No Brasil&#44; no per&#237;odo de outubro de&#160;1997 a novembro de&#160;1998&#44; foi realizado estudo multic&#234;ntrico delineado como coorte prospectiva&#44; constitu&#237;da por&#160;259&#160;pacientes portadores de hansen&#237;ase PB&#8208;LU&#58; 75&#160;no estado do Amazonas&#44; 59&#160;em Goi&#225;s&#44; 80&#160;no Rio de Janeiro e 45&#160;em Rond&#244;nia&#46; Todos foram tratados com o esquema ROM e tiveram mediana de tempo de seguimento de&#160;31&#160;meses&#46; No seguimento&#44; 216&#160;&#40;83&#44;4&#37;&#41; casos foram avaliados como curados&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">De acordo com os dados da literatura mundial e os resultados do estudo brasileiro&#44; o Minist&#233;rio da Sa&#250;de do Brasil &#40;MS&#41;&#44; em&#160;2002&#44; recomendou o esquema ROM como tratamento alternativo em centros de refer&#234;ncia&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">No &#250;ltimo guia de controle da hansen&#237;ase &#40;MS&#44; 2017&#41; n&#227;o h&#225; refer&#234;ncia sobre o tratamento ROM e inexistem explica&#231;&#245;es sobre sua exclus&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Por outro lado&#44; nas recomenda&#231;&#245;es para o tratamento da hansen&#237;ase&#44; em&#160;2020&#44; a OMS continua recomendando o esquema ROM&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Procuramos avaliar a evolu&#231;&#227;o cl&#237;nica dos&#160;75&#160;pacientes do estado do Amazonas alocados no estudo brasileiro&#44; principalmente com rela&#231;&#227;o &#224; ocorr&#234;ncia de eventos como rea&#231;&#245;es&#44; neurites e retratamento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para essa an&#225;lise&#44; foram realizadas buscas no banco de dados do Sistema de Informa&#231;&#227;o de Agravos de Notifica&#231;&#227;o &#40;SINAN&#41; e seus prontu&#225;rios&#46; Apenas um prontu&#225;rio n&#227;o foi localizado&#46; Procuramos tamb&#233;m resgatar pacientes para exame dermatol&#243;gico&#44; por meio de contato telef&#244;nico&#46; Nenhum paciente foi localizado&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Na investiga&#231;&#227;o do banco de dados do SINAM n&#227;o foi encontrada informa&#231;&#227;o sobre reingresso de pacientes por falha terap&#234;utica&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Por meio da an&#225;lise dos prontu&#225;rios&#44; verificou&#8208;se que&#160;33&#160;pacientes retornaram ao servi&#231;o&#58; 19&#160;com queixas n&#227;o relacionadas &#224; hansen&#237;ase e 14&#160;para reavaliar a enfermidade&#46; De acordo com as informa&#231;&#245;es coletadas&#44; quatro pacientes apresentaram sinais de prov&#225;vel reativa&#231;&#227;o da doen&#231;a&#44; cinco a seis anos ap&#243;s o tratamento &#8211; tr&#234;s casos informavam reativa&#231;&#227;o ou aumento do tamanho da les&#227;o&#44; e um&#44; classificado como indeterminado&#44; desenvolveu neurite &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Nos prontu&#225;rios n&#227;o havia informa&#231;&#245;es sobre resultados de bi&#243;psias ou baciloscopias positivas&#46; Os exames dermatol&#243;gicos n&#227;o foram realizados pelos dermatologistas envolvidos na pesquisa&#46; Os crit&#233;rios de falha terap&#234;utica&#44; ap&#243;s 20 anos&#44; foram exclusivamente cl&#237;nicos e n&#227;o tiveram comprova&#231;&#227;o definitiva da inefic&#225;cia do tratamento&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Ressaltamos que o esquema ROM &#233; recomendado pela OMS e deve ser considerado como esquema alternativo para tratamento dos casos PB com les&#227;o &#250;nica&#44; principalmente nos centros de refer&#234;ncia&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0070" class="elsevierStylePara elsevierViewall">Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado do Amazonas &#40;FAPEAM&#41; &#8211; bolsa inicia&#231;&#227;o cient&#237;fica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0075" class="elsevierStylePara elsevierViewall">Silmara Navarro Pennini&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o&#44; revis&#227;o e aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Josineide de Oliveira Novo Fran&#231;a&#58; Revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e revis&#227;o do manuscrito&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Paula Frassinetti Bessa Rebello&#58; Concep&#231;&#227;o e planejamento do estudo&#59; revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Sin&#233;sio Talhari&#58; Revis&#227;o cr&#237;tica da literatura&#59; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o&#44; revis&#227;o cr&#237;tica do manuscrito e aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;MB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento do n&#250;mero de les&#245;es&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rea&#231;&#227;o reversa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falha terap&#234;utica&#47;aumento da les&#227;o inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vinte anos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falha terap&#234;utica&#47;aumento da les&#227;o inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falha terap&#234;utica&#47;aumento da les&#227;o inicial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falha terap&#234;utica&#47;neurite &#40;um nervo&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PRED&#47;PQT&#8208;PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2878243.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Fonte&#58; Rebello PF&#46; Hansen&#237;ase paucibacilar les&#227;o &#250;nica&#58; perspectivas de implementa&#231;&#227;o do esquema poliquimioter&#225;pico em dose &#250;nica &#40;disserta&#231;&#227;o de mestrado&#41;&#46; Goi&#226;nia&#44; Universidade Federal de Goi&#225;s&#59; 2001&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Causas de retratamento de hansen&#237;ase les&#227;o &#250;nica tratados com ROM no estado Amazonas</p>"
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      ]
    ]
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      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0055"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
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                          "colaboracion" => "World Health Organization &#91;Internet&#93;"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Weekly epidemiological Record&#46;"
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                        "paginaInicial" => "225"
                        "paginaFinal" => "232"
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              "identificador" => "bib0060"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enhanced global strategy for further reducing the disease burden due to leprosy &#40;&#63;2011&#8208;2015&#41;&#63;&#58; plan period&#58; 2011&#8208;2015&#41;&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "World orld Health Organization &#91;Internet&#93;"
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Regional Office for South&#8208;East Asia&#44; New Delhi"
                        "fecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization &#91;Internet&#93;&#46; World Health Organization &#91;Internet&#93;&#46; Geneva&#58; Chemotherapy of leprosy for Control Programmes&#58; report of a WHO study group &#91;&#63;meeting held in Geneva from 12 to 16 October 1981&#93;&#63;&#46; Dispon&#237;vel em&#58; https&#58;&#47;&#47;apps&#46;who&#46;int&#47;iris&#47;handle&#47;10665&#47;38984&#46;"
                ]
              ]
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            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Expert Committee on Leprosy&#58; seventh report"
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                        0 => array:2 [
                          "colaboracion" => "World Health Organization &#91;Internet&#93;"
                          "etal" => false
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                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "WHO technical report series"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single&#8208;lesion Multicentre Trial Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Efficacy of single dose multidrug therapy for the treatment of single lesion paucibacillary leprosy"
                          "etal" => false
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Lepr&#46;"
                        "fecha" => "1997"
                        "volumen" => "69"
                        "paginaInicial" => "121"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9290963"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hansen&#237;ase paucibacilar les&#227;o &#250;nica&#58; perspectivas de implementa&#231;&#227;o do esquema poliquimioter&#225;pico em dose &#250;nica Goi&#226;nia&#46; Disserta&#231;&#227;o &#91;Mestrado&#93; &#8211; Universidade Federal de Goi&#225;s"
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                      "doi" => "10.1016/j.intimp.2022.108697"
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                  "contribucion" => array:1 [
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                      "titulo" => "Single lesion paucillary leprosy&#58; baseline profile of the Brazilian Multicenter cohort study"
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                          "etal" => true
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                            0 => "C&#46;M&#46; Martelli"
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                            2 => "M&#46;C&#46; Gomes"
                            3 => "P&#46;F&#46; Rebellos"
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                        "tituloSerie" => "Int J Lepr Other Mycobact Dis&#46;"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brasil&#58; Secretaria de Pol&#237;ticas de Sa&#250;de Departamento de Aten&#231;&#227;o B&#225;sica"
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                      "titulo" => "Brasil&#58; Secretaria de Vigil&#226;ncia em Sa&#250;de Departamento de Vigil&#226;ncia das Doen&#231;as Transmiss&#237;veis"
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Article information
ISSN: 26662752
Original language: Portuguese
DOI:10.1016/j.abdp.2022.01.007
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